As a parent guardian, I do hereby authorize first aid medical treatment of my child in the event of an emergency which may endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if delayed. It is understood that efforts will be made to reach me as soon as reasonably possible.
IF PERSON BEING USED IN THE MATERIAL IS UNDER 18 YEARS OF AGE, PARENT OR LEGAL GUARDIAN MUST SIGN THIS FORM.
I/we give my/our permission to the Corpus Christi Catholic School, the Roman Catholic Diocese of Grand Rapids, Michigan, (the Diocese) and all
entities, representatives, employees, and agents operating under its authority to use, without prior notice, my
name or my minor child’s name, city and state, and/or audio, video(s), photo(s), and/or any other likeness and
to use statements made by or attributed to me or my child relating to the Diocese, without compensation, for
web, social media, publicity or similar promotions for the Diocese. I waive my right to inspect or approve such
publications, including any written copy that may be created in connection therewith. I/we agree that my/our
signature(s) below releases any and all claims against the Roman Catholic Diocese of Grand Rapids, or
its associated entities related to or arising out of the Diocese’s use of the stated items as media
Dear Parent / Guardian:
Complete this section ONLY if you are requesting advance notification of a pesticide application by United States Postal Service first-class mail.
Please be advised that you WILL receive notice via the methods identified in the annual advisory
notice and should only complete this form if you are also requesting notification by first-class mail.
If you are requesting prior notification of pesticide treatments conducted at this school or day care center, other than a bait or gel formulation, and you would like the notice to be delivered by United States Postal Service first-class mail, postmarked at least 3 days prior to the planned treatment, please complete the information below.